Healthcare Provider Details

I. General information

NPI: 1639225261
Provider Name (Legal Business Name): PROGRESSIVE MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 LOKER AVE W SUITE P
CARLSBAD CA
92010-6604
US

IV. Provider business mailing address

2720 LOKER AVE W SUITE P
CARLSBAD CA
92010-6604
US

V. Phone/Fax

Practice location:
  • Phone: 760-448-4448
  • Fax: 760-448-4449
Mailing address:
  • Phone: 760-448-4448
  • Fax: 760-448-4449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number43639
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number43639
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number43639
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number43639
License Number StateCA

VIII. Authorized Official

Name: MRS. HELEN A. KENT
Title or Position: PRESIDENT
Credential: RRT
Phone: 760-448-4448